Adverse antibiotic effects associated with renal insufficiency

Rev Infect Dis. 1990 Mar-Apr;12(2):236-49. doi: 10.1093/clinids/12.2.236.


We review the English-language literature on antibiotic-associated adverse reactions in patients with renal insufficiency in order to highlight this important but often overlooked clinical problem. Because many adverse reactions to antibiotics are not dependent on renal function, we have attempted to review only those reactions that are believed to be associated with renal insufficiency or that have been reported in patients with impaired renal function. Adverse effects of antibiotics in this setting can be divided into six major categories: neurologic toxicity, coagulopathy, nephrotoxicity, hypoglycemia, hematologic toxicity, and aminoglycoside inactivation by penicillins. Neurologic toxicity can be further divided into central nervous system toxicity consisting primarily of encephalopathy and seizures, ototoxicity, peripheral neuropathy, and neuromuscular blockade/respiratory depression. We explore the factors in uremia that may contribute to the susceptibility of patients with renal insufficiency to the adverse effects of antibiotics. Moreover, we make general recommendations regarding the use of the discussed antibiotics in patients with compromised renal function.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Acute Kidney Injury / metabolism*
  • Aminoglycosides
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / antagonists & inhibitors
  • Anti-Bacterial Agents / pharmacokinetics
  • Blood Coagulation Disorders / chemically induced
  • Bone Marrow Diseases / chemically induced
  • Humans
  • Hypoglycemia / chemically induced
  • Kidney Diseases / chemically induced
  • Kidney Failure, Chronic / metabolism*
  • Male
  • Middle Aged
  • Nervous System Diseases / chemically induced
  • Penicillins / adverse effects


  • Aminoglycosides
  • Anti-Bacterial Agents
  • Penicillins